Effect of Magnesium Sulphate with Bupivacaine in Ultrasound-guided Transversus Abdominis Plane Block in patients undergoing Total Abdominal Hysterectomy

Background: Transversus abdominis plane block is a valuable component of multimodal analgesia regimen. Magnesium sulphate has been shown to increase the duration of action of different peripheral nerve blocks. We assessed the efficacy of magnesium sulphate as an adjuvant to bupivacaine in transversus abdominis plane block in patients scheduled for total abdominal hysterectomy under general anaesthesia. Methods: Sixty-six patients undergoing total abdominal hysterectomy under general anaesthesia were divided into two groups. Ultrasound-guided bilateral transversus abdominis plane block was performed in both groups before extubation. Bupivacaine alone group received block with 20ml of 0.25% bupivacaine while Bupivacaine with Magnesium group received block with 20ml of 0.25% bupivacaine with 150mg of magnesium sulphate on each side. Pain scores at 0, 2, 4, 6, 12, and 24 hours postoperatively along with time to first request of analgesia, total consumption of fentanyl, and incidence of nausea or vomiting were noted. Results: Group BM showed significantly lower pain scores at 4 and 6 hours (p=0.001 and 0.017 respectively). Time to first request of analgesia was significantly more in Group BM [285 minutes (85, 370) vs. 75 minutes (52.5, 150), (p<0.001)]. Total postoperative fentanyl consumption was significantly less in Group BM (230±59.06 mcg vs. 289.85±69.13 mcg, p<0.001). Conclusions: Bupivacaine with magnesium sulphate in transversus abdominis plane block after total abdominal hysterectomy under general anaesthesia results in lower post-operative pain scores, longer duration of analgesia and less postoperative fentanyl requirement with no difference in the incidence of nausea/vomiting compared with bupivacaine alone

Regulation of Surgical Procedures and Health Care Facilities Rankings in Nepal

Globally, millions of surgeries are performed each year to compliment and manage a diverse set of medical conditions. Adverse surgical outcomes constitute a major proportion of avoidable death and disabilities in the hospital, especially in low-income countries like Nepal. A comprehensive study on the standards of surgical procedures and its institutional regulations is missing. We discuss here the importance of surgical regulation based on it’s financial as well as healthcare implications in the Nepalese healthcare system. Keywords: surgical procedures; health care facilities; safety; surgery; WHO.

Accidentally Missed Guidewire during Insertion of a Dialysis Catheter

Missed guidewire is a rare and potentially avoidable complication of central venous cannulation. Unsupervised insertion by trainees, distraction during insertion, and high workload may increase the risk. Simple measures such as holding onto the wire at all times until removal from the vessel, routine use of central venous catheter insertion checklist, and vigilant supervision of the trainees may help prevent missing of the guidewire

Need for Improvement of Medical Records

Introduction: A medical record is a systematic documentation of a patient’s medical history and care for legal and future use. A poor quality medical record can negatively affect patient care and safety. The study aims to assess the adequacy of medical records in Bir Hospital, a central hospital. Methods:A cross-sectional study was conducted by analyzing consecutive discharge summaries of patients admitted during a 6 month period in a single unit of a tertiary care center. The discharge summary format of the hospital was taken as the standard and evaluation for adequacy of data entered was assessed. Descriptive statistics were used to analyze various statistical discrepancies. Results: Patient’s condition at discharge was missing in 86 (66.15%). Patient’s address was missing in 21 (16.1%) cases. Almost all the discharge sheets lacked mailing address. Total 96 (73.8%) had use of abbreviations diagnosis. Age and sex were missing in 1 (0.76%). Doctor’s signature was illegible in 103 (79.3%) and missing in 2 (1.5%) summaries. Doctor’s name and their level/position were missing in 118 (90.76%) and 125 (96.1%) respectively. Total 126 patients (96.9%) were not given any instructions on discharge. Conclusions: The discharge summaries analyzed were seen to be inadequate especially in documenting course during the hospital stay, condition at discharge, appropriate instructions and the treating physician’s details. These can probably be addressed by introducing electronic medical records if feasible. Otherwise, the discharge summary should be standardized and doctors should be trained to write legible, complete discharge summaries. Key Words: discharge, hospital, records, summarie